Individual
DON R DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
803 W MARKET ST STE 100, LIMA, OH 45805-2796
(419) 996-5063
(419) 996-5502
Mailing address
1920 EVANS AVE, CHEYENNE, WY 82001-3716
(307) 637-5339
(307) 637-4525
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
6812A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119369400
—
WY
01
—
312715
BLUE CROSS BLUE SHIELD
WY
Enumeration date
09/22/2006
Last updated
09/30/2024
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